Provider Demographics
NPI:1255669511
Name:HENDERSON, ANGELA (LICSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-0673
Mailing Address - Country:US
Mailing Address - Phone:301-793-1512
Mailing Address - Fax:301-793-1512
Practice Address - Street 1:64 NEW YORK AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3320
Practice Address - Country:US
Practice Address - Phone:202-698-2431
Practice Address - Fax:202-698-2466
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50078799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health